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r o I co <br /> COUNTY OF SAN JOAQUIN <br /> Environmental Health Department <br /> 1868 E Hazelton Avenue <br /> Stockton, California 95205 <br /> Telephone (209)468-3420 <br /> FAX (209)468-3433 <br /> Website:www.sjgov.org/ehd <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> Please read the information on the reverse side before completing this survey form. A separate survey for each business <br /> name and/or address in San Joaquin County is required. <br /> Business <br /> Name: Yandell Tr_uckaway, Inc. <br /> Business Owner(s) <br /> Name: John Yandell, Jr. Telephone: 925-988-9800 <br /> Business <br /> Address: 1002 N. Broadway Avenue, Stockton, CA 95205 <br /> Mailing Address (if different from <br /> above): P.O. Box 818, Oakland, CA 94604 <br /> Nature of <br /> Business: Company Owned Truck/Trailer Repair Fire District: <br /> Q1. OYes ❑No Does your business handle a hazardous material in any quantity at any one time In the year? See the <br /> definition of hazardous material on the back of this form. If your answer is No,"go to Question 4. <br /> Q2. MYes ❑No Does your business handle a hazardous material, or a mixture containing a hazardous material in a <br /> ` quantity equal to or greater than 55 gallons, 500 pounds, or 200cubic feet at any one time in the year? <br /> j If"Yes,"how long have you handled these materials at your business?50 yrs <br /> If"Yes,"check any of the following conditions that applies to your business. <br /> SA. The hazardous materials handled by this business is contained solely in a consumer product, <br /> packaged for direct distribution to, and use by, the general public, <br /> 1:1 B. This business is a health care facility(doctor, dentist, veterinary, etc.)and uses onlymedical <br /> gases. <br /> ❑C. This business operates a farm for purposes of cultivating the soil, raising, or harvesting an <br /> agricultural or horticultural commodity. <br /> Q3. ❑Yes WNo Does your business handle an acutely hazardous material? See definition on reverse side of this <br /> form. <br /> Q4, ❑Yes WNo Is your business within 1,000 feet of the outer boundary of a school (grades K-12)? <br /> i <br /> I have read the information on this form and understand my requirements under Chapter 6.95 of the California Health and <br /> Safety Code. I understand that if I own a facility or property that is used by tenants, that it is my responsibility to notify the <br /> tenants of the requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. <br /> I declare under the penalty of perjury that the information provided on this disclosure survey is true and accurate to the <br /> best of my knowledge. Q <br /> Owner or Authorized Aggnt: 05�18�2021 <br /> (John onac(�.Jr. /, Date: <br /> Prif e Owner <br /> X Title: -- — -- - <br /> i Sig ElWre <br /> C <br />